Nine Potential Treatment Options for Plantar Fasciitis
Plantar fasciitis is one of the most common known causes of foot and heel pain around the world today, affecting millions of people. Although it is typically associated with hard charging athletes and regular weekend runners, the sometimes debilitating condition can also strike the everyday, 9-5 person too.
In this article we’ll take a close look at what exactly plantar fasciitis is, how it is caused, and what your options are to go about treating it effectively.
Let’s dig in…
What is Plantar Fasciitis?
Also known as jogger’s heel, plantar fasciitis occurs when the plantar fascia ligament that connects your heel to your toes becomes damaged, weakened, swollen or inflamed. It is usually characterized by a sharp pain or dull ache at the base of the heel or bottom of the foot upon standing, and in rare cases can also accompanied by tingling and numbness.
Any movements that involve putting excessive weight onto the foot, or those that involve dorsiflexion (closing the angle between the foot and shin) can sometimes exacerbate the condition.
For many people with plantar fasciitis, the first few steps in the morning are often the most painful, as the ligament is cold and stiff from being completely inactive overnight.
Pain may subside throughout the day, but can worsen after long periods of standing or climbing flights of stairs.
What Causes Plantar Fasciitis?
There are a number of risk factors that can contribute to the injury, many of which are interlinked in some shape or form.
A strain or tear of the plantar fascia ligament becomes more likely due to:
Poor walking mechanics: If your feet tend to roll inwards (pronation) or roll outwards (supination) an excessive amount when you walk, run, climb stairs or exercise; the plantar fascia ligament can be stretched beyond its normal capacity, leading to a strain or tear.
Foot arch issues: Some people are born with naturally high arches, and at the other end of the spectrum, some have overly flat feet. In both cases, extra stress is often placed on the plantar fascia ligament. Arch issues are also commonly related to the faulty walking mechanics mentioned above.
Structural imbalances: You’ve probably heard that a tight achilles tendon or shortened calf muscles can place excess strain on the plantar fascia. But it goes even deeper than that. If your hips lack full range of motion or you have mid back stiffness, these issues can lead to downstream imbalances and faulty foot mechanics. It’s all connected. A good litmus test is that if you can’t get into a deep squat without rounding your back, turning your feet out, or standing on your toes, you have some work to do…
Prolonged standing: If you are walking, standing, or running for long periods of time (particularly on hard surfaces) your risk of damaging the plantar fascia increases. This is not only due to the increased amount of stress the ligament is exposed to, but also because these longer time frames lead to tiredness, which can lead to sloppy mechanics and subsequent injury.
Unsuitable footwear: If you’re wearing a shoe that has a heel, you’re unnecessarily predisposing yourself to injury. That elevated heel (even the one on your gym trainers) puts the foot into a constant state of plantar flexion (think pointing the foot). This shortens the calf muscles and achilles tendon, which as mentioned above, rarely ends well. To minimize your risk of injury, safely transition to more minimal, zero drop footwear.
Underlying conditions: Some inflammatory medical conditions such as rheumatoid arthritis and lupus may predispose you to developing plantar fasciitis as the body is already in an inflamed state.
Undesirable body composition: Being overweight puts much more pressure on the plantar fascia compared to people who maintain a healthy weight, increasing the risk of developing a strain or tear.
Plantar Fasciitis Treatment Options
So now you know all about why plantar fasciitis can occur and what you can do to minimize your chances of getting injured. Let’s assume you’ve followed all the correct procedures, but you get a little unlucky and still end up with a strain.
It’s been said that 90% of plantar fasciitis occurrences will improve within a year without any treatment whatsoever, but to us a year of pain and discomfort doesn’t sound like fun, especially when there is an alternative.
Here are some of the most common strategies employed in an attempt to speed up recovery. They range from simple effective to wacky and downright dangerous.
As always, please consult a medical practitioner to discuss your treatment options before going ahead with anything.
1. Physical Therapy
A trained physical therapist is one of the first people you should turn to if you suspect an issue with the plantar fascia.
They’ll typically look for the underlying cause of the problem and try to improve general foot mechanics, reducing the likelihood of causing more damage. They may also prescribe specific mobility exercises or massage techniques, and may make use of some of the other methods that we will mention later – including supplements and electro-therapy.
Verdict – great if you work with a qualified practitioner who is looking to solve the underlying cause, as well as relieve pain.
2. Mobility Exercises
As mentioned in the previous section, poor body positioning and structural imbalances are on of the main underlying causes of plantar fasciitis.
Websites such as Mobility WOD provide detailed instruction on how to free up the hips, lengthen the calf muscles, release the bottom of the foot, and generally improve mobility to take some of the strain off of the plantar fascia, relieve pain, and reduce the risk of further damage.
Verdict – can be great if you perform targeted exercises, typically with the help of a qualified instructor or therapist.
3. Extracorporeal Shock Wave Therapy
Although it may sound a little bizarre, extracorporeal shock wave therapy (ESWT) has actually been shown to be one of the more effective methods for treating plantar fasciitis.
It involves the use of sound waves that are pulsed through the ligament to promote healing. At the present moment, most shock wave therapy treatments are quite expensive and require anesthetic, although progress is being made.
Verdict – a good way to alleviate pain and speed up healing, but should be used in conjunction with preventative measures to reduce the risk of future injuries.
4. Custom Orthotics
Some therapists or medical professionals may advise the use of custom orthotics to combat plantar fasciitis. These are inserts shaped to your foot that are placed inside your shoes to adjust your foot positioning. If for example, you are someone over over pronates, they can help to bring your position back to neutral.
A heel pad is also sometimes used to cushion the heel if you’re someone who spends a large portion of their day stood on hard surfaces.
Although these products can be useful for some people, others argue that addressing the underlying mechanics is a far more important factor, and should be considered if you’re looking for a long time solution.
As reddit user dihard points out:
“Orthotics are necessary only when your pain is debilitating enough to prevent you from even performing the proper rehab and posture correction exercises or you’re about to go to or coming out of surgery, and even in these cases should be a temporary measure. In reality, this probably describes less than 1% of orthotics wearers, most slap them on for life in place of actually correcting the causal elements”.
Verdict – can be useful if the pain is too much for you to perform corrective exercises, but in most cases probably shouldn’t be relied upon as a long term solution.
5. A Walking Cast
In some cases when the pain is too intense to perform simple movements such as walking or running, doctors may prescribe a full foot cast.
This locks the foot in a slightly flexed position that allows the plantar fascia to heal in a stretched, rather than shortened manner.
The cast does force you to rest your foot, which may improve the recovery time for the injury. However, as pointed out over at Web MD:
“having your foot in a cast for several weeks causes some weakening of the foot, ankle, and calf muscles and some loss of flexibility. After the cast is removed, you will need some rehabilitation to restore strength and range of motion”.
Verdict – can be useful if the pain is too intense to perform normal daily activities, but in normal cases should not be used before other methods such as mobilisation and…
6. Ice and Compression
Ice packs to the heel and even ice block to massages to the plantar can be a great way to bring down the associated swelling and inflammation.
As the guys over at Heel that Pain point out:
“When an injury occurs, the body rushes blood and fluids to the injury site. This is an important part of the healing process, but it can be accompanied by significant pain. With moderate use of ice, blood vessels can be temporarily constricted to slow down the flow and prevent the leakage of blood. At the same time, the cold has a numbing effect on the tissues, reducing nerve sensations of pain. You shouldn’t ever over-ice an injury – this can lead to tissue damage, but appropriate use can minimize discomfort on a temporary basis”.
As well as icing, many people swear by the use of compression gear (such as bandages and socks) to support the injured area, reduce pain and promote faster healing.
Verdict – Ice and compression can definitely be useful in helping to reduce pain and increase the speed of healing, but alone will not prevent plantar fasciitis from occurring again in the future.
7. Healthy Eating
It goes without saying that a nutrient dense diet plays a massive role in helping you to maintain an overall healthy, active lifestyle; but it may also directly impact your plantar fasciitis.
The condition is inflammatory in nature, meaning that if you consume foods that regularly promote inflammation (such as dairy, refined sugar and processed foods) then it’s likely that the inflammation will last for longer.
Conversely, eating plenty of anti-inflammatory foods such as leafy greens, omega-3 rich nuts and seeds, and antioxidant filled dark berries will help to bring down inflammation and improve the rate of recovery.
As we’ve previously discussed here one the Eu Natural blog, you could also add into the mix anti-inflammatory herbs and spices such as turmeric, ginger, boswellia and peppermint, that have been shown to reduce inflammation and pain. It should be noted however, that simply reducing inflammation levels does not necessarily mean that the root cause of the issue is being fully addressed. It’s what’s actually causing the inflammation that’s the real issue.
And last but not least, your hydration levels can also play a key role in determining your injury status. Studies have shown that dehydration can increase the risk of developing a knee or foot injury, therefore it’s imperative to make sure you’re consuming enough water each day (2-3 litres per day).
Verdict – Although eating healthily will not provide immediate relief, it is a key part of the health picture, and is something that can increase the speed of recovery and reduce the risk of developing further injuries.
8. Medical Treatments
A common treatment method prescribed by traditional medical practitioners is the use of non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen. Whilst they may help to bring down inflammation levels, they also bring along the risk of experiencing a whole host of unwanted side effects, including stomach ulcers, high blood pressure and heart problems.
Natural herbs and spices such as ginger and turmeric have been shown to reduce pain and inflammation just as well, without any adverse side effects.
Less commonly used are cortisone injections into the ligament, which can numb the pain for up to several months. Again, this treatment does not come without it’s risks, including death of nearby bone, loss of ligament strength, nerve damage and infection.
Verdict – Although steroidal injections and NSAIDs can help to relieve pain, some argue that their negative impacts outweigh the positives, and you’re better off using natural anti-inflammatories such as turmeric and ginger.
The last, and probably most extreme treatment method we’ll explore in this article is plantar fascia surgery.
It generally involves the surgeon making an incision somewhere in the plantar fascia to relieve the tension. If heel spurs are present and aggravating the condition, they may also be removed. The surgery is typically followed up by a few weeks of inactivity and a foot cast.
Although it can be a necessary evil in some cases, the surgery does not come risk free. In some cases it can lead to recurring heel pain, nerve damage and infection.
Verdict – Surgery should likely be reserved for extreme situations, and in most should not be used as a primary treatment for plantar fasciitis.
Have you ever suffered with plantar fasciitis? If so, what treatment methods did you find to be the most effective?